Annex A > Chapter 4 - National Accountabilities and Roles > National regulatory and professional bodies > Professional regulation - nursing: the UKCC
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Professional regulation - nursing: the UKCC
The statutory basis
138 The UKCC's role is broadly analogous to that of the GMC. [164] Ms Lavin gave evidence to the Inquiry about the legal foundations of the UKCC and its relationship to the National Boards: [165]
`1. The UKCC, together with the four National Boards (in England, Scotland, Wales and Northern Ireland), regulates the education and practice of nurses, midwives and health visitors. The 1997 Act is a consolidation of the 1979 Act which established these bodies, and the 1992 Act which reformed their powers and composition.
`2. The role of these statutory bodies is to define standards for the education, clinical practice, and professional conduct of nurses, midwives and health visitors; and to monitor the implementation and effectiveness of these standards. Broadly, the UKCC is responsible for standard setting and conduct procedures, including maintaining the register of professionals deemed fit to practice. The National Boards are responsible, within their respective countries, for oversight of the implementation of education standards and other related functions. The 1979 Act brought together all the statutory bodies concerned with regulating the professions at both pre- and post-registration levels and rationalised the regulatory structures across the UK.
`3. A review of the organisation and functioning of the five statutory bodies in 1989 led to the 1992 Act and changes in legislation - the UKCC became the directly elected body and the National Boards became smaller, executive bodies appointed by the respective Secretaries of State (and, for Northern Ireland, the Head of the Department of Health and Social Services for Northern Ireland). All professional conduct functions were transferred to the Central Council.
`4. Nurses have been regulated under statutory professional self-regulation since 1919; and midwives since 1902. Until 1979, health visitors were regulated through their nursing qualification, with other arrangements made under a separate body for their education and training as health visitors.' [166]
139 Ms Lavin [167] referred the Inquiry to the statutory provisions governing the professional conduct of nurses, midwives and health visitors: the Nurses, Midwives and Health Visitors Act 1997, the Nurses, Midwives and Health Visitors Rules Approval Order 1983, [168] the Nurses, Midwives and Health Visitors (Professional Conduct) Rules 1993 Approval Order 1993 [169] and the Nurses, Midwives and Health Visitors (Professional Conduct) (Amendment) Rules 1998 Approval Order 1998. [170]
140 Ms Lavin explained the functions of the National Boards:
`The functions of the Boards are to:
- `approve institutions to provide courses of training
- `ensure that courses of training meet Central Council requirements as to their kind, content and standard
- `hold or arrange for others to hold such examinations as are necessary to satisfy requirements for registration or additional qualifications
- `collaborate with Council in promotion of improved training methods and
- `provide advice and guidance to Local Supervising Authorities for midwives.
`In addition the Boards are to carry out any other functions prescribed by the relevant Secretary of State.
`In addition to their primary function of the implementation and monitoring of Council standards for education, all the National Boards have additional functions. These are specified in the statutory instruments through which they were established in each country; any may differ from country to country. These functions include careers information, research into training methods, provision of courses of training and further training for nurse, midwifery and health visitor teachers and provision of a central applications system (Scotland). The constitution of the National Boards is prescribed in the [1997] Act and elaborated in statutory instruments.' [171]
141 The four UK Health Departments commissioned J M Consulting Ltd to:
`... review the legislation which regulates the education and practice of nurses, midwives and health visitors and the five statutory bodies which operate it'. [172]
142 J M Consulting Ltd is an independent, Bristol-based, company that specialises in conducting public sector reviews on commission from national agencies, particularly in the higher education and health sectors.
143 The review was announced in Parliament in July 1997. [173] At its conclusion, J M Consulting Ltd produced `The Regulation of Nurses, Midwives and Health Visitors' [174] which sets out the history and background to the Nurses, Midwives and Health Visitors Act 1997. [175]
144 One matter to emerge from the review was that the relationship between the UKCC and the National Boards could be improved [176] and indeed, the Government has accepted proposals to replace the UKCC and National Boards with a Nursing and Midwifery Council. [177]
Relative roles and responsibilities of the UKCC and the Royal College of Nursing
145 Although the UKCC's role is broadly analogous to that of the GMC, the relationship between the Royal College of Nursing (RCN) and the UKCC is different in nature from the relationship between the GMC, BMA and the Royal Colleges. The table of comparisons below helps to explain the respective roles of the RCN and the UKCC.
| | RCN | UKCC |
|---|---|---|
| Founded | 1916 | `Nurses have been regulated under statutory professional self-regulation since 1919; and midwives since 1902. Until 1979, health visitors were regulated through their nursing qualification, with other arrangements made under a separate body for their education and training as health visitors.' [15] UKCC was established by the Nurses, Midwives and Health Visitors Act 1979 |
| Constitution | Royal Charter granted 1928 It is a voluntary association It is a trade union - nurses may also belong to Unison, or another trade union which is open to membership from health professionals | Statutory: Nurses, Midwives and Health Visitors Acts 1997, Nurses, Midwives and Health Visitors Rules Approval Order 1983, [16] Nurses, Midwives and Health Visitors (Professional Conduct) Rules 1993 Approval Order 1993, [17] Nurses, Midwives and Health Visitors (Professional Conduct) (Amendment) Rules 1998 Approval Order 1998 [18] |
| Charitable status | Registered charity | |
| Headquarters | London | London |
| Responsible to whom? | `The College is accountable to Her Majesty the Queen in Privy Council' [19] | `The UKCC is an autonomous body ... accountable to the public for their safety through Parliament (the Secretary of State), and accountable to registrants for the proper discharge of its functions on their behalf' [20] |
| Responsible for | Nurses | Nurses, midwives and health visitors |
| Aims | `To promote the science and art of nursing and the better education and training of nurses and their efficiency in the profession of nursing' [21] and other aims | |
| Number of members | 318, 000 | 634, 229 [24] |
| Sources of funding | Membership subscriptions, gifts [25] | `UKCC is ... funded principally by registrants' [26] |
| Basic membership | | |
| Higher membership | No higher categories of membership | UKCC's register has 15 parts |
| Fellowship | No higher categories of membership | |
| Is membership a requirement for employment? | No | Yes. Registration is compulsory for nurses, midwives and health visitors who want to practice [27] |
| Training post approval | No | Approval of institutions to provide courses of training; the quality of such courses is the responsibility of the National Boards [28] |
| Standard setting | `The RCN is a leading player in the development of nursing practice and standards of care.' [29] `The RCN offers its members a wide range of services including: development of nursing practice and standards of care'; [30] `the Dynamic Quality Improvement Programme has focused on development work, including ... developing specialist guidelines and standards'; [31] `an initial programme of work to develop national standards for particular speciality areas was undertaken in the late 1980s and early 1990s. This resulted in the production of standards for a whole range of specialist subjects' [32] | See aims above |
| Current President | Christine Watson (General Secretary: Christine Hancock) [33] | Alison Norman |
| Discipline of members | `The RCN can remove members from membership, although this power has never been used' [34] | As the professional regulatory body, it has sanctions for misconduct and ill health |
| Continuing Professional Development (CPD)/Continuing Medical Education (CME) | `The RCN offers its members a wide range of services including: ... education and professional development activities.' RCN has a continuing education points (CEP) system [35] | |
| Historic links to other colleges | `The RCN has a good track record in working with other organisations in order to improve health care' [38] | |
| [15] WIT 0052 0002 Ms Lavin [16] SI 1983 No 873 [17] SI 1993 No 893 [18] SI 1998 No 1103 [19] WIT 0042 0003 Miss Hancock [20] WIT 0052 0007 Ms Lavin [21] WIT 0042 0004 Miss Hancock [22] Nurses, Midwives and Health Visitors Act 1997, section 2(1) [23] WIT 0052 0001 Ms Lavin [24] UKCC 0001 0001 total number of registrants 1998/1999 [25] WIT 0042 0004 Miss Hancock [26] WIT 0052 0007 Ms Lavin [27] Nurses, Midwives and Health Visitors Act 1997, section 13 [28] WIT 0052 0004; WIT 0052 0223 Ms Lavin; T33 p.136-8 Ms Lavin [29] WIT 0042 0003 Miss Hancock [30] WIT 0042 0003 Miss Hancock [31] WIT 0042 0005 Miss Hancock [32] WIT 0042 0005 Miss Hancock [33] Until May 2001 [34] WIT 0042 0003 Miss Hancock [35] T34 p.124-5 Mrs Jenkins; WIT 0042 0003 Miss Hancock [36] See `PREP and You', UKCC, October 1997; WIT 0052 0089 [37] WIT 0052 0203 `The Regulation of Nurses, Midwives and Health Visitors; Report on a Review of the Nurses, Midwives and Health Visitors Act 1997' [38] WIT 0042 0025 Miss Hancock |
Fitness to practise: nurses
146 The statutory definition of `misconduct' for nurses: `conduct unworthy of a registered nurse...' [178] is broadly similar to the GMC's `serious professional misconduct', and has been described as vague and unhelpful. [179] A charge of `misconduct' cannot be brought simply by citing a breach of a provision of the `Code of Professional Conduct', although the `The Regulation of Nurses, Midwives and Health Visitors' proposes such a change.
147 Charges of misconduct against nurses, as with doctors, must be proved beyond a reasonable doubt. However, when the UKCC does not pursue a case to a hearing because the evidence is not strong enough to meet this threshold, or it is dropped for another reason, there is other action that the UKCC can take. The UKCC has a practice of writing to practitioners:
`... indicating areas where they might want to reflect on practice, for instance, in relation to the administration of medicines or in relation to guidance on records and record-keeping'. [180]
Limits of disciplinary powers
148 The statutory powers of the UKCC, like those of the GMC, appear to be restricted. [181] It has no power, for instance, to impose a life ban on nurses (i.e. removal from the Register with no right to reapply for registration). [182] J M Consulting Ltd in its review did not support the introduction of this power. [183] The GMC similarly does not currently have the power to impose a life ban but has requested the Government for such a power. The Government has indicated its willingness to enact the necessary legislation.
Alternative sanctions and interventions
149 The Government supports the proposal to give the UKCC's successor Council the power to impose sanctions other than removal from the Register, for instance the power to remove the registered marks of a nurse's higher level qualifications or specialism without going so far as to remove the nurse's basic registration. [184]
150 Although the UKCC is complaints-oriented, [185] and thus reactive like the GMC, it has been more punitive in its approach than the GMC. Differential treatment of Doctors and nurses is reflected in the different rates of their being removed from the Register.
151 The UKCC advised the Inquiry of the number of nurses, midwives and health visitors registered with the UKCC and the number removed by the Professional Conduct Committee (PCC), for 1995/96-1999/2000. The following table sets out the figures: [186]
152 The reporting period for each year covers 1 April to 31 March. In addition, the UKCC's Health Committee removed and suspended a number of registrants on health grounds.
153 By comparison, there are about 100, 000 doctors practising in the UK [187] but only a few are erased from the medical register each year, as is indicated by the figures in the next two paragraphs.
154 The GMC provided the Inquiry with statistics for each year of the period of the Inquiry's Terms of Reference relating to the progress of complaints to various stages of the GMC disciplinary procedures. The number of cases referred to the PCC were: [188]
| | 1984 | 1985 | 1986 | 1987 | 1988 | 1989 | 1990 | 1991 | 1992 | 1993 | 1994 | 1995 |
| No of cases | 52 | 42 | 49 | 53 | 33 | 35 | 51 | 31 | 35 | 59 | 83 | 117 |
155 The number of erasures (with immediate suspension) relating to clinical performance (in the sense of disregard of professional responsibilities and irresponsible prescribing only) were: [189]
156 The UKCC feels it is currently constrained as regards the flexibility of its response to those facing disciplinary action by its limited repertoire of responses:
`The difficulty we have at the moment is, we have nothing in between no action and a caution, [190] which remains on the register for five years. That is a pretty big gap in terms of flexibility of response to cases.' [191]
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Footnotes
[165] The National Boards for England, Scotland, Wales and Northern Ireland
[166] WIT 0052 0001 - 0002 Ms Lavin
[167] WIT 0052 0016, 0278 Ms Lavin
[168] SI 1983 No 873
[169] SI 1993 No 893
[170] SI 1998 No 1103
[171] WIT 0052 0004 - 0005 Ms Lavin
[172] WIT 0052 0188 Ms Lavin
[173] WIT 0052 0216 Ms Lavin
[174] WIT 0052 0183 Ms Lavin; `The Regulation of Nurses, Midwives and Health Visitors - Report on a Review of the Nurses, Midwives and Health Visitors Act 1997'
[175] WIT 0052 0218 Ms Lavin
[177] T33 p.152 Ms Lavin; WIT 0052 0322; `Review of the Nurses, Midwives and Health Visitors Act 1997 - Government Response to the Recommendations HSC 1999/030' , p. 6 (dated 9 February 1999)
[178] WIT 0052 0055; Nurses, Midwives and Health Visitors (Professional Conduct) Rules 1993 Approval Order 1993, Rule 1(2)(k)
[179] WIT 0052 0205, 0249 Ms Lavin; `The Regulation of Nurses, Midwives and Health Visitors'
[181] WIT 0052 0190; `The Regulation of Nurses, Midwives and Health Visitors', overview para 12(g); WIT 0052 0251 Ms Lavin
[182] WIT 0052 0015 Ms Lavin
[183] WIT 0052 0251; `The Regulation of Nurses, Midwives and Health Visitors'
[184] WIT 0052 0326 `The new register will include marks against registrant's [sic] entries to indicate enrolled nurse status, specialisms (within nursing) and higher level qualifications. A further level of public protection can be afforded by making it possible for these marks to be removed (for example, on the grounds of unfitness to practise or failure to meet periodic re-registration conditions) without the practitioner being removed from the register.' `Review of the Nurses, Midwives and Health Visitors Act 1997 - Government Response to the Recommendations HSC 1999/030'
[185] WIT 0052 0009 Ms Lavin
[186] UKCC 0001 0001; letter from Rebecca Blease to Peter Whitehurst, 15 September 2000
[187] T48 p.18 Sir Donald Irvine. `Of the total doctors on the Medical Register, the ball-park would be around 180, 000. But of those, around 100, 000 practise in the National Health Service. Many of our registrants are overseas or retired. The operating figure for this country is effectively 100, 000.'
[188] WIT 0051 0136 Mr Hamilton. `Figures have been taken from [GMC] Annual Reports for 1984-1994 and from the Report to Council of the work of the PPC in 1995.'
[189] WIT 0051 0137 Mr Hamilton. `Figures taken from [GMC] Annual Reports 1984-1995. Figures in brackets and marked (R) denote the number of cases which were resumed from an earlier hearing in a previous year. Figures in brackets and not marked (R) are the number of cases in which an order for the immediate suspension of the doctor's registration was also made.'
[190] T33 p.156 Ms Lavin. `... a caution can only be given by the Preliminary Proceedings Committee in circumstances where a practitioner admits the facts of a case and admits misconduct. It is to deal with one-off deviances...'